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I Am Asian, and Had Upper and Lower Bleph. Is It Possible to Lower my Eyelid Crease?
It's been 11 days since my upper and lower bleph and I am very unhappy with the upper
eyelid result. I originally just wanted a lower bleph to remove the dark circles. My
doctor recommended I also do upper eyelids to remove the excess hooded skin (I am 43
years old, & had Asian double eyelid surgery 25 yrs ago). Even though there is some swelling,
I believe the incision on the upper eyelids are way too high for my Asian eyes. I've have
been researching for an eyelid specialist to have a revision.
Thank you for your question!
You've submitted some photos after undergoing Asian Eyelid surgery 11 days ago. And although
you acknowledge in your question that you know that there is some swelling that you
already believe that the eyelid crease sensation is too high. So certainly you are entitled
to at least have a concern. It is probably a little bit too early to start seeking advice
for revision surgery.
You see, Asian eyelid surgery, once you have a relative amount of experience, is the principles
are relatively straightforward. Understanding that Asian eyelid crease is a little bit lower,
there has to be a fold and the position of that crease is typically several millimeters
lower than a Caucasian crease. Now one of the things that gets people very nervous in
the beginning is swelling that causes an artificial widening of the crease. You see the eyelid
platform is what you're looking at and you're interpreting that the crease is too high.
Now what generally happens is that, with time, we're talking about eyelid surgery can take
several months even up to a year to go away. But generally, people start to notice an appreciable
difference at the first week, about one month and 3 months. So you can just compare those
photos to get a sense of what's going on.
Now there are times that the crease can be artificially too high if fat was removed or
there's a hollowing process. But in terms of the actual crease placement and the fixation
just to understand what Asian eyelid surgery is,, is basically when someone doesn't have
an eyelid crease of has single eyelid or a monolid, there is something that I look at
to determine what type of eyelid surgery to do. The first thing I look at is if there's
excess skin. That gives a me a decision-making point of whether or not to do an excisional
procedure where a strip of skin is removed or a non-incisional procedure where we're
making actual openings in the skin and anchoring the skin to a particular muscle called the
levator muscle. And the levator muscle like the word elevator is the muscle responsible
for lifting the eyelid and creating the crease in that way. Some people with Asian technique
would make almost an artificial technique where they'll actually use tape to create
this artificial crease that tends to work for most people but eventually some people
will get frustrated with the continuous application of this tape.
Now the other parts of the equation is, is there fat and is that fat responsible for
obliterating or making difficult to have a proper crease. So with those factors understood,
I make a decision whether or not remove skin and how much fat to be removed at the time
of surgery. But the common thing is that we are creating an adhesion or connection between
the eyelid skin and the levator muscle. So I think at this point, you certainly can get
additional opinions. But I think most people you go to will say to you that you have to
wait and you have to wait to allow swelling to go down because no one wants to intervene
in a situation where the tissue is swelling. I always I tell people who come to me with
a similar situation that if I were to go in while the situation is swelling, I'm working
with a moving target. And can't do accurate surgery when things are very swollen. There
are exceptions to the rule but as a general basis when there's no evidence of infection
or any type of unusual inflammation, there's no reason to go in when the tissue is just
so early in the healing phase.
Now there is some timing that is helpful. Sometimes we wait until just some enough swelling
is going down to and do a procedure, a revision, not necessarily Asian eyelid surgery, but
other eyelid surgery because I want to minimize the amount of scar formation but then that
is determined by case to case basis. So I think what you really need to do is talk to
your doctor. Stay in communication with your doctor, follow-up and if you had made your
decision to have this doctor do your surgery, mostly likely that you were impressed that
the doctor had enough experience with Asian eyelid surgery and so I wouldn't say just
to abandon all hope at this point. So I thank you for your question and I hope that was
helpful.